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目的系统评价并比较三种抗凝凝方案用于房颤患者经皮冠状动脉介入治疗(PCI)术后的效果。方法检索Pub Med、EMbase、The Cochrane Library、CBM、CNKI、万方数据库、VIP数据库,搜集有关房颤患者PCI术后抗凝凝方案应用效果的随机对照研究(RCT)或队列研究;抗凝方案包括双联抗血小板治疗(DAPT)、三联抗凝治疗(华法林联合DAPT,TT)以及华法林联合一种抗血小板药物(W+SAPT);检索时限均为建库至2016年3月。由2位评价者独立筛选文献、评价纳入研究质量和提取资料,采用ADDIS1.16.6软件进行Meta分析,评价三种抗凝方案的应用效果。结果共纳入8项研究,包括2 484例房颤患者,均为亚洲人。纳入研究收敛性良好,非一致性检验无统计学意义。TT组缺血性卒中风险低于DAPT组(OR为0.32,95%CI为0.08~0.80,P<0.05),三种抗凝方案缺血性卒中风险由低到高依次为W+SAPT、TT、DAPT。TT组主要不良心脑血管事件发生风险低于DAPT组(OR为0.55,95%CI为0.28~0.97,P<0.05),三种抗凝方案主要不良心脑血管事件风险由低到高依次为TT、DAPT、W+SAPT。TT组大出血事件风险高于DAPT组(OR为3.24,95%CI为1.79~5.81,P<0.05),三种抗凝方案大出血事件风险由低到高依次为DAPT、W+SAPT、TT。结论对于亚洲房颤PCI术后患者,采用TT方案抗凝凝可减少不良心脑血管事件,但增加了出血风险;DAPT方案抗凝则卒中风险较高;W+SAPT或许是平衡栓塞风险与出血风险的方案。
Objective To systematically evaluate and compare the efficacy of three anticoagulation protocols for percutaneous coronary intervention (PCI) in patients with atrial fibrillation. Methods A randomized controlled study (RCT) or cohort study was conducted on PubMed, EMbase, The Cochrane Library, CBM, CNKI, Wanfang database and VIP database. The anticoagulation protocol Including dual antiplatelet therapy (DAPT), triple anticoagulant therapy (warfarin plus DAPT, TT) and warfarin in combination with an antiplatelet agent (W + SAPT); . The two reviewers independently screened the literature, evaluated the quality of the study, extracted the data, and performed the meta-analysis using the ADDIS1.16.6 software to evaluate the effect of the three anticoagulation protocols. Results A total of 8 studies were included, including 2,484 patients with atrial fibrillation, all Asian. Convergence into the study of good, non-consistency test was not statistically significant. The risk of ischemic stroke in TT group was lower than that in DAPT group (OR 0.32, 95% CI 0.08 to 0.80, P <0.05). The risk of ischemic stroke in three anticoagulation programs was W + SAPT, TT , DAPT. The risk of major adverse cardiac and cardiovascular events in TT group was lower than that in DAPT group (OR 0.55, 95% CI 0.28-0.97, P <0.05). The risk of major adverse cardiac and cerebrovascular events in the three anticoagulation programs was TT, DAPT, W + SAPT. The risk of major bleeding in TT group was higher than that in DAPT group (OR 3.24, 95% CI 1.79-5.81, P <0.05). The risk of major bleeding in the three anticoagulation programs was DAPT, W + SAPT, TT in descending order. Conclusions Anticoagulation with TT regimen may reduce adverse cardiovascular and cerebrovascular events in patients with AF in Asia after PCI, but may increase the risk of bleeding; DAPT may have a higher risk of stroke with anticoagulation; W + SAPT may be associated with risk of embolization and bleeding Risk of the program.